Back in the 1990s, we started work on pedagogical agents — a novel paradigm for interactive learning. Pedagogical agents are autonomous characters that inhabit learning environments to engage with ...learners in rich, face‐to‐face interactions. Building on this work, in 2000, together with our colleague Jeff Rickel, we published an article on pedagogical agents (Johnson, Rickel, and Lester 2000) that surveyed and discussed the potential of this new paradigm. We made the case that pedagogical agents that interact with learners in natural, lifelike ways can help learning environments achieve improved learning outcomes. This article has been widely cited, and was a winner of the 2017 IFAAMAS Award for Influential Papers in Autonomous Agents and Multiagent Systems.1
On the occasion of receiving the IFAAMAS award, and after 20 years of work on pedagogical agents, we take another look at the future of the field. We start by revisiting the predictions we made in 2000 for pedagogical agents, and examine which predictions panned out. Then, informed by what we have learned since then, we take another look at emerging trends and reexamine the future of pedagogical agents. Advances in natural language dialogue, affective computing, machine learning, virtual environments, and robotics are making possible even more lifelike and effective pedagogical agents, with potentially profound effects on the way people learn.
Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition ...screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 2.03-4.20 p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 1.03-3.48 p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m
) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.
The COVID-19 pandemic caused many workers to lose their jobs, and also resulted in rapid surges in demand for workers with particular skills. In public health there was suddenly a huge demand for ...community health workers to conduct contact tracing, vaccination, and community outreach. To address this need, our team undertook the challenge of creating an online course that trains workers for community health work in half the time of typical training programs. It utilizes the Enskill® learning platform, which uses AI technology to create simulated scenarios in which trainees practice skills with avatars acting as simulated patients. Fifty-seven training participants without college degrees were recruited for the program from the Hampton Roads region, in collaboration with the Hampton Roads Workforce Council. The first cohorts of trainees were able to complete the training successfully in just eight weeks, and are now being placed in public health and healthcare positions. The approach also shows promise for upskilling existing employees to address skill gaps. The Enskill training program is a competitor in the XPRIZE Foundation’s Rapid Reskilling competition, to quickly reskill under-resourced workers for the digital revolution.
Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: ...malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients' views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer.
Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis.
n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 95% CI: 1.26-6.89, p = 0.013) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 95% CI: 1.24-4.19, p = 0.008), and visible wasting (OR 8.43 95% CI: 1.9-37.3 p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 95% CI: 1.87-40.60 p = 0.006) with cachexia. Screening tools identified established conditions rather than 'risk'. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients' perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities.
Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly 'at risk' are identified whilst conditions are more remediable to interventions.
Although certain human genetic variants are conspicuously loss of function, decoding the impact of many variants is challenging. Previously, we described a patient with leukemia predisposition ...syndrome (GATA2 deficiency) with a germline GATA2 variant that inserts 9 amino acids between the 2 zinc fingers (9aa-Ins). Here, we conducted mechanistic analyses using genomic technologies and a genetic rescue system with Gata2 enhancer-mutant hematopoietic progenitor cells to compare how GATA2 and 9aa-Ins function genome-wide. Despite nuclear localization, 9aa-Ins was severely defective in occupying and remodeling chromatin and regulating transcription. Variation of the inter-zinc finger spacer length revealed that insertions were more deleterious to activation than repression. GATA2 deficiency generated a lineage-diverting gene expression program and a hematopoiesis-disrupting signaling network in progenitors with reduced granulocyte-macrophage colony-stimulating factor (GM-CSF) and elevated IL-6 signaling. As insufficient GM-CSF signaling caused pulmonary alveolar proteinosis and excessive IL-6 signaling promoted bone marrow failure and GATA2 deficiency patient phenotypes, these results provide insight into mechanisms underlying GATA2-linked pathologies.
The Tactical Language and Culture Training System (TLCTS) helps people quickly acquire communicative skills in foreign languages and cultures. More than 40,000 learners worldwide have used TLCTS ...courses. TLCTS utilizes artificial intelligence technologies during the authoring process and at run time to process learner speech, engage in dialogue, and evaluate and assess learner performance. This paper describes the architecture of TLCTS and the artificial intelligence technologies that it employs and presents results from multiple evaluation studies that demonstrate the benefits of learning foreign language and culture using this approach.
This paper summarizes the Spirit rover operations in the Columbia Hills of Gusev Crater from sols 513 to 1476 and provides an overview of selected findings that focus on synergistic use of the Athena ...Payload and comparisons to orbital data. Results include discovery of outcrops (Voltaire) on Husband Hill that are interpreted to be altered impact melt deposits that incorporated local materials during emplacement. Evidence for extensive volcanic activity and aqueous alteration in the Inner Basin is also detailed, including discovery and characterization of accretionary lapilli and formation of sulfate, silica, and hematite‐rich deposits. Use of Spirit's data to understand the range of spectral signatures observed over the Columbia Hills by the Mars Reconnaissance Orbiter's Compact Reconnaissance Imaging Spectrometer (CRISM) hyperspectral imager (0.4–4 μm) is summarized. We show that CRISM spectra are controlled by the proportion of ferric‐rich dust to ferrous‐bearing igneous minerals exposed in ripples and other wind‐blown deposits. The evidence for aqueous alteration derived from Spirit's data is associated with outcrops that are too small to be detected from orbital observations or with materials exposed from the shallow subsurface during rover activities. Although orbital observations show many other locations on Mars with evidence for minerals formed or altered in an aqueous environment, Spirit's data imply that the older crust of Mars has been altered even more extensively than evident from orbital data. This result greatly increases the potential that the surface or shallow subsurface was once a habitable regime.
We compared the outcome of COVID‐19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID‐19 from March 1, ...2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID‐19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models. We also compared the primary endpoint in SOT patients to an age, gender, and comorbidity‐matched control group. Bivariate analysis found transplant status, age, gender, race/ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR <60 mL/min/1.73 m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio OR 1.29; 95% CI 0.99–1.69, p = .06). Compared to an age, gender, and comorbidity‐matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03–1.74, p = .027).
In an early experience from New York, hospitalized solid organ transplant recipients with COVID‐19 are more likely to reach a combined endpoint of death or mechanical ventilation than a large population of comorbidity‐matched controls.
Pedagogical agent research seeks to exploit Reeves and Nass's media equation theory, which holds that users respond to interactive media as if they were social actors. Investigations have tended to ...focus on the media used to realize the pedagogical agent, e.g., the use of animated talking heads and voices, and the results have been mixed. This paper focuses instead on the manner in which a pedagogical agent communicates with learners, i.e., on the extent to which it exhibits social intelligence. A model of socially intelligent tutorial dialog was developed based on politeness theory, and implemented in an agent interface within an online learning system called virtual factory teaching system. A series of Wizard-of-Oz studies was conducted in which subjects either received polite tutorial feedback that promotes learner face and mitigates face threat, or received direct feedback that disregards learner face. The polite version yielded better learning outcomes, and the effect was amplified in learners who expressed a preference for indirect feedback, who had less computer experience, and who lacked engineering backgrounds. These results confirm the hypothesis that learners tend to respond to pedagogical agents as social actors, and suggest that research should focus less on the media in which agents are realized, and place more emphasis on the agent's social intelligence.
By designing well‐defined, single‐site asymmetric organometallic complexes anchored to a concave siliceous support (see picture) high ee values may be obtained in heterogeneous catalytic ...hydrogenations. O red, Si orange, Rh yellow, C grey, N blue, F green, B pink, H white.
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